PHOENIX ZOO – SOUTH AFRICA - Splendid Safaris

PARKER TRAVEL
TOUR RESERVATION FORM
Est. 1981
Yes! We wish to participate in the Phoenix Zoo - South Africa Safari - February/March 2013.
Please confirm space for the following participants (full names exactly as they appear on passports):
1. Full Name (as on passport) _______________________________________________________________ Gender: ❏ M ❏ F Date of Birth: _______________
2. Full Name (as on passport) _______________________________________________________________ Gender: ❏ M ❏ F Date of Birth: _______________
Street Address: _______________________________________________________________________________________________________________________
City: ____________________________________________________________________________ State: _________________ Zip __________________________
Home Phone: ______________________________________________________________ Work:_______________________Cell Phone:_____________________
Email: _______________________________________________________________________________________ Fax:_____________________________________
Deposit: Enclosed is my/our deposit in the amount of $__________________________ ($1,000 per person).
Kindly make check or money order payable to “Parker Travel – Client Trust Account” and mail to:
Parker Travel, 4801 E. McKellips Rd., Suite 103, Mesa, AZ 85215.
(Note: Deposit can be made by credit card (attach Credit Card Authorization Form). However, the final payment must be by check or money order)
Optionals:
❏ I/We wish to participate in the Shark Cage Dive (additional $195 per person)
❏ I/We wish to participate in the Victoria Falls Extension (additional as per e-Brochure)
Air Transportation:
❏ I/We wish to travel with the group from: ❏ Phoenix, or ❏ Other City _____________________________________________________________________ or
❏ I/We will make our own arrangements, and we will provide you with a copy of our air itinerary
❏ Contact me/us with a quote to upgrade to Business Class or First Class airfare.
Travel Insurance:
Parker Travel strongly suggests that you obtain travel insurance protection for this journey. Upon confirmation of your reservation, Parker Travel will send you
information on a travel insurance protection program for your consideration. Note: In order to take advantage of the “pre-existing conditions” coverage, the Travel
Insurance must be purchased prior to or at the time final payment is made (by November 15, 2012).
Special Requests/Comments (Smoking/Non-Smoking Rooms, Roommate Request, etc.):
PHOENIX ZOO
SOUTH AFRICA SAFARI
February 23 to March 6, 2013
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
❏ I am sharing a room with ____________________________________________ (submitting their own Registration Form).
❏ We prefer a room with: ❏ One Bed or ❏ Two Beds
❏ I am traveling alone, but would like a roommate. I understand that Parker Travel will attempt to find a roommate; however, I will pay the additional Single
Supplement if no roommate is found. I prefer a: ❏ Non-Smoker ❏ Smoker
❏ I definitely require single accommodations, and agree to pay the single supplement.
I/We certify that I/we are in generally good physical condition, and free of any condition which would interfere with the operation, safety, or enjoyment of the
group or its members.
I/We have read and understood the Terms & Conditions on the reverse, and agree to be bound by them. This includes, among other provisions, that the deposit
is non-refundable; that the final payment is due by November 15, 2012; that the airfare is additional and will be determined at the time the group is formed (approximately
four months prior to departure), and that the airfare is currently estimated to be $2,400 per person from Phoenix; that Parker Travel strongly suggests
that you obtain travel insurance protection for this journey; and that neither the Phoenix Zoo, nor the Arizona Zoological Society, nor any of their officers, directors,
employees, representatives, agents or affiliates, are liable for any act, event, or occurrence with regard to this journey.
Signature _______________________________________________________________________________________________Date ________________________
Signature _______________________________________________________________________________________________Date ________________________